Physical pain, psychological distress and the deleterious effects of medical procedures all cause the chronically ill to suffer as they experience their illnesses. However, a narrow medicalized view of suffering, solely defined as physical discomfort, ignores or minimizes the broader significance of the suffering experienced by debilitated chronically ill adults. A fundamental form of that suffering is the loss of self in chronically ill persons who observe their former self-images crumbling away without the simultaneous development of equally valued new ones. As a result of their illnesses, these individuals suffer from (1) leading restricted lives, (2) experiencing social isolation, (3) being discredited and (4) burdening others. Each of these four scores of suffering is analysed in relation to its effects on the consciousness of the ill person. The data are drawn from a qualitative study of 57 chronically ill persons with varied diagnoses.

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Serious chronic illness undermines the unity between body and self and forces identity changes. To explicate how the body, identity, and self intersect in illness, one mode of living with impairment, adapting, is explicated in this article. Adapting means altering life and self to accommodate to bodily losses and limits and resolving the lost unity between body and self. It means struggling with rather than against illness. The process of adapting consists of three major stages: (1) experiencing and defining impairment, (2) making bodily assessments and, subsequently, identity trade-offs, as ill people weigh their losses and gains and revise their identity goals, and (3) surrendering to the sick self by relinquishing control over illness and by flowing with the experience of it. Adapting seldom occurs only once. Rather chronically ill people are. forced to adapt repeatedly as they experience new losses. The data consist of 115 interviews about experiencing chronic illness and 25 more focused interviews about the body in chronic illness. The strategies of grounded theory provided the methods for completing the analysis.Chronic illness assaults the body and threatens the integrity of self. Having a serious chronic illness shakes earlier taken-for-granted assumptions about possessing a smoothly functioning body. It also disturbs a person's previous assumptions about the relation between body and self and disrupts a sense of wholeness of body and self (cf. Monks and Frankenberg n.d.; Murphy 1987).Thus, chronic illness with impairment intrudes upon a person's daily life and undermines self and identity. #at happens when people have chronic illnesses that weaken, challenge, or negate valued images of their bodies? How do beliefs, images, and expectations of one's body affect present identity and future hopes and plans? What kinds of goals do people form for their future identities after they have experienced loss of bodily function or disability?To explicate how the body, identity, and self intersect in illness, I outline one mode of living with impairment or loss of bodily function: adapting. By adapting, I mean altering life and self to accommodate to physical losses and to reunify body and self accordingly. Adapting implies that the individual acknowledges impairment and alters life and self in socially and personally acceptable ways. Bodily limits and social circumstances often force adapting to loss. Adapting shades into acceptance. Thus, ill people adapt when they try to accommodate and flow with the experience of illness.

The pragmatist roots of constructivist grounded theory make it a useful method for pursuing critical qualitative inquiry. Pragmatism offers ways to think about critical qualitative inquiry; constructivist grounded theory offers strategies for doing it. Constructivist grounded theory fosters asking emergent critical questions throughout inquiry. This method also encourages (a) interrogating the taken-for-granted methodological individualism pervading much of qualitative research and (b) taking a deeply reflexive stance called methodological self-consciousness, which leads researchers to scrutinize their data, actions, and nascent analyses. The article outlines how to put constructivist grounded theory into practice and ends with where this practice could take us.

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